School-Based Influenza Vaccination: Health and Economic Impact of Maine's 2009 Influenza Vaccination Program.

OBJECTIVE: To estimate the societal economic and health impacts of Maine's school-based influenza vaccination (SIV) program during the 2009 A(H1N1) influenza pandemic. DATA SOURCES: Primary and secondary data covering the 2008-09 and 2009-10 influenza seasons. STUDY DESIGN: We estimated weekly monovalent influenza vaccine uptake in Maine and 15 other states, using difference-in-difference-in-differences analysis to assess the program's impact on immunization among six age groups. We also developed a health and economic Markov microsimulation model and conducted Monte Carlo sensitivity analysis. DATA COLLECTION: We used national survey data to estimate the impact of the SIV program on vaccine coverage. We used primary data and published studies to develop the microsimulation model. PRINCIPAL FINDINGS: The program was associated with higher immunization among children and lower immunization among adults aged 18-49 years and 65 and older. The program prevented 4,600 influenza infections and generated $4.9 million in net economic benefits. Cost savings from lower adult vaccination accounted for 54 percent of the economic gain. Economic benefits were positive in 98 percent of Monte Carlo simulations. CONCLUSIONS: SIV may be a cost-beneficial approach to increase immunization during pandemics, but programs should be designed to prevent lower immunization among nontargeted groups.

Mass arsenic poisoning and the public health response in Maine.

Created in the wake of the September 11, 2001 terrorist attacks, Maine's Office of Public Health Emergency Preparedness within the Maine Center for Disease Control and Prevention undertook a major reorganization of epidemiology and laboratory services and began developing relationships with key partners and stakeholders, and a knowledgeable and skilled public health emergency preparedness workforce. In 2003, these newly implemented initiatives were tested extensively during a mass arsenic poisoning at the Gustav Adolph Lutheran Church in the rural northern community of New Sweden, Maine. This episode serves as a prominent marker of how increased preparedness capabilities, as demonstrated by the rapid identification and administration of antidotes and effective collaborations between key partners, can contribute to the management of broader public health emergencies in rural areas.